Introduction: The botulinum toxin is a valuable option for the treatment of dynamic facial wrinkles. The Lanzhou botulinum toxin type A (LBTX-A) was introduced in China in the early 90’s and approved in Brazil in 2003. Objective: Evaluate the efficacy and tolerability of LBTX-A for the cosmetic treatment of dynamic wrinkles of the upper face. Material and Methods: In a prospective, open-label, multicenter study, 110 subjects of both sexes (aged from 25 to 65 years) were treated with a total of 53 U of LBTX-A each, distributed in fi fteen sites in the frontal, corrugator, procerus, orbicular ocular lateral muscles. The patients were reviewed 7 times within 180 days. Efficacy was assessed by electromyography, photographic analysis and the investigator’s and patient’s opinions. Tolerability was assessed by the incidence of adverse events.Results: Two weeks post-injection, 94% of the treated patients considered the result as good or excellent. Results lasted 90 days in most cases. After injection, most patients reported mild or no pain, and minimal and reversible side effects as facial edema (6 patients), stuffiness feeling (3 patients) and eyelid ptosis (2 patients). Conclusions: We conclude that LBTX-A is effi cient and well tolerated for the treatment of dynamic facial lines.

Keywords: BOTULINUM TOXIN TYPE A, INJECTABLES, WRINKLES, FACIAL DYNAMIC LINES

Structural alterations resulting from the aging process of the face are related to muscular action, skin sagging, loss of bone support, and decrease in the volume of facial fat compartments-all inducing alterations in facial contour over the years. The authors have carried out a review of the main causes linked to the so-called facial contour alteration in aging and defined a new denomination for this process: "facial squaring", the process through which the shape of the face-which is that of an inverted trapezoid in youth-becomes that of a square over time.

Keywords: REJUVENATION; SKIN; FACIAL MUSCLES.

Introduction: Facial paralysis triggers asymmetries and other functional and aesthetic facial changes, which lead to significant physical and psychological disorders. Botulinum toxin type A is a safe, effective, and well-tolerated therapy, making it a good option for treating those conditions. Objective: To demonstrate the clinical improvement and the degree of satisfaction among patients bearing facial asymmetries and dyskinesias, who have been treated with botulinum toxin type A injections performed by dermatologists. Methods: Patients with facial asymmetries and dyskinesias were selected between January 2011 and December 2013, to receive botulinum toxin injections aimed at reducing muscle activity on the normal side of the face (in cases of facial hemiparesis) or directly into the affected muscles in cases of dyskinesias. The clinical evaluations and photographic records in static and dynamic positions were carried out on the days of the first application (D0) and fifteen days after (D15). Each patient was rescheduled for a future session within120 days. Results: There was clinical improvement with reduction of asymmetries and dyskinesias verified at the beginning of treatment following application of the toxin. A significant improvement in the patients' quality of life, with a positive impact in different areas of their personal lives, could be noticed. Conclusions: Treatment with botulinum toxin type A, performed by dermatologists with previous experience in the management of this procedure in other conditions, proved to be an important alternative in the treatment of asymmetries and facial dyskinesias.

Keywords: FACIAL ASYMMETRY; FACIAL PARALYSIS; QUALITY OF LIFE; BOTULINUM TOXINS, TYPE A.

Introduction: The application of botulinum toxin in the perioral region is a minimally invasive procedure that leads to substantial improvement in the signs of aging in addition to increasing the volume of the lips. However literature on this procedure is still scarce.
Objective: To evaluate changes in shape and volume of the lips, as well as the patients' satisfaction after the application of botulinum toxin in perioral lines.
Methods: Nineteen patients underwent evaluation, photographic record and measurements following the application of botulinum toxin in the perioral region, being subsequently assessed for changes in the lips and satisfaction.
Results: Most of the patients rated their lips as moderately or significantly more attractive after the application of botulinum toxin (p = 0.039). Fifteen women deemed the changes in the lips as a major factor in the overall improvement of their faces.
Conclusions: The use of botulinum toxin in the perioral region leads to the elevation of the upper lip, causing the shortening of the philtrum and the extension of the vermilion. The application of botulinum toxin in the vermilion's border leads to the relaxation of the orbicularis muscle, favoring a more intense tonus effect arising from the upper lip lifting muscles. The patients' satisfaction with the appearance of their lips was evaluated by four additional questions (linked to the lip's shape, volume, attraction and beauty), receiving positive answers. Side effects were minimal.

Keywords: LIP; BOTULINUM TOXINS, TYPE A; BOTULINUM TOXINS

Introduction: Currently there is a growing demand for non-invasive therapies aimed at treating facial aging. Non-ablative fractional lasers lead to excellent outcomes, with reduced side effects. Objective: To evaluate the facial rejuvenation achieved by 1,340nm non-ablative fractional laser using a single pass at high energy versus three passes at medium energy, through a prospective comparative study. Methods: Twenty patients with facial aging were treated with 2 or 3 laser sessions with 4-week intervals. The right hemiface was treated with three passes of 1,340nm non-ablative fractional laser at a fluence of 90 mJ, pulse duration of 5ms and 100 mtz/ cm2. The left hemiface was treated with a single pass of the same laser at a fluence of 120 mJ, pulse duration of 5ms and 100 mtz/cm2. The evaluated variables were spots, wrinkles, porphyrins and overall appearance. Results: The patients (n = 20) were evaluated during 6 to 24 months. The photographic evaluations demonstrated a significant improvement of the spots on the right hand side and wrinkles on the right and left hand sides. Eighteen of the 20 patients reported satisfaction with the treatment. Conclusion: 1,340nm non-ablative fractional laser was proven as a modern, safe and effective alternative for facial rejuvenation. For spots, the triple passes at medium energy protocol led to a superior response. However, regarding wrinkles there was no difference between the single pass at high energy and triple pass at medium energy protocols.

Keywords: LASER; REJUVENATION; FACIAL AGING; FACE

The association of cysts and comedones in chronically sun-damaged skin characterizes the Favre-Racouchot syndrome. The authors report a case of a 64 year-old male patient with a history of smoking and tillage work activity. The patient had lesions in the malar, zygomatic and mandibular regions bilaterally, constituted by slightly erythematous cysts and large comedones in thickened skin with deep grooves. The condition was diagnosed as Favre-Racouchot syndrome, and treated by means of surgical excision. The objective of the present study is to describe an exuberant presentation of the syndrome, and its treatment via surgical excision.

Keywords: Facial dermatoses; Photosensitivity disorders; Skin aging

Facial hemiatrophy, or Parry-Romberg syndrome, is characterized by the progressive atrophy of the tissues of half of the face, affecting skin and subcutaneous tissue. Its clinical manifestations are very varied. Preferred therapeutic strategies for the treatment of the syndrome were not yet completely established. The authors describe a case of mild facial hemiatrophy, in which the patient underwent lipofilling (autologous fat grafting), progressing with satisfactory result. Treatment alternatives, its advantages and disadvantages are widely discussed in the study, with fat grafting emerging as an excellent therapeutic option due to its safety, low cost and replicability.

Keywords: Face; Facial hemiatrophy; Transplantation, autologous

Brooke-Spiegler syndrome is a rare autosomal dominant genetic disease with predisposition to many adnexal tumors, including trichoepithelioma, cylindroma and spiroadenoma. Tumors appear in the second decade of life, progressively increase with age, and their prevalence is higher in women. It is caused by a mutation in the CYLD gene, localized in the chromosome 16q12-q13. We report a exuberant case of giant eccrine spiradenoma associated to this syndrome.

Keywords: Dermatologic Surgical Procedures; Facial Neoplasms; Neoplasms, Adnexal and Skin Appendage

The application of botulinum toxin to patients with sequelae of Bell's palsy is a beneficial adjuvant therapy for the reduction of synkinesia and facial asymmetries. Bell's palsy is the most common cause of facial nerve paralysis.After the paralysis phase of the facial muscles, the condition may evolve with facial asymmetry and synkinesia. In the treatment of synkinesia, punctual injections into the orbicularis and platysma muscles relieve the spasms. Selective application to the unaffected hemiface aims to reduce facial asymmetry and its negative social impact, with improved quality of life.

Keywords: Facial paralysis; Bell palsy; Botulinum toxins, type A; Rehabilitation; Quality of life

INTRODUCTION: Patients often request anti-aging treatments of the perioral and periorbital regions. Most of the time, it is necessary to use a combination of procedures, so the result meets the patient’s expectations.
OBJECTIVE: This is a prospective, single-center, and comparative study assessing the rejuvenation of the perioral and periorbital regions after treatment with medium depth chemical peel using phenol 88% with or without the previous application of botulinum toxin.
METHODS: Sixteen patients underwent regional peel with phenol 88%; eight received botulinum toxin application two weeks before. The assessment was conducted using standard photographs and evaluation scales by doctors and patients.
RESULTS: The overall evaluation by doctors and patients on the 45th day was considered excellent or good for all patients, with little advantage for combined treatment in the periorbital region.
CONCLUSION: Combining these two relatively low-cost procedures, often overlooked by dermatologists, resulted in a significant improvement in the changes related to aging in these areas.

Keywords: Botulinum toxins type A; Chemexfoliation; Phenol; Rejuvenation

Nodular fasciitis is a benign tumor resulting from the reactive proliferation of fibroblastic or myofibroblastic cells presenting rapid growth and rich cellularity. In adults, the extremities’ involvement is more frequent; however, other regions can be affected. In this report, we present the case of a 40-year-old woman with a nodular lesion on the forehead. The histopathology confirmed the diagnosis of nodular fasciitis. The reported case highlights its rare location and alerts the clinical dermatologist in its inclusion among the differential diagnoses of tumor lesions on the face.

Keywords: Facial Dermatoses; Fasciitis; Forehead

Frontal fibrous alopecia is a primary lymphocytic scarring alopecia that is difficult to control, with a perifollicular lichenoid infiltrate marking its histology. Since its description in 1994 by Kossard, there has been an increase in cases reported worldwide. This article reports two cases that underwent incisional biopsies with longitudinal and transverse sections in areas presenting higher disease activity and reviews some aspects of this dermatosis. It also addresses the suspicion of a possible relationship with the application of botulinum toxin – a question already raised by other authors but with no established confirmation.

Keywords: Alopecia; Botulinum toxins; Botulinum toxins type A

INTRODUCTION: The use of botulinum toxin has become one the essential cosmetic procedures performed in the world.
OBJECTIVE: To identify patterns of muscle contraction of the forehead, glabellar complex, and orbicularis oculi muscle in patients from southern Brazil, establishing their epidemiology and possible associations between them.
METHODS: One hundred and one patients who sought treatment with botulinum toxin for the forehead, glabella, and periocular lines between 2012 and 2016 were included. Analyzes were made using digital photographs taken during a medical consultation before applying the products., The subjects received with different brands of botulinum toxin, according to the patients’ or the doctors’ preference
RESULTS: The most common contraction patterns were complete frontal, glabellar in converging arrows, and complete periocular. Women represented 94.1% of patients. Most patients were between 31 and 50 years old, with an average of 44.57 years. More frequent patterns in each area were more frequently associated.
CONCLUSIONS: The study shows the main muscle contraction patterns of the upper third of the face in 101 patients, as well as their clinical characteristics, comparing them with previously published articles. Studies on muscle contraction patterns can assist in the safer and more rational use of the products available, avoiding waste and complications.

Keywords: Muscle contraction; Skin aging; Face; Facial muscles; Botulinum toxins type A

INTRODUCTION: Progressive Facial Hemiatrophy, also known as Parry Romberg Syndrome, is a rare form of linear scleroderma. The management of facial atrophy sequelae is challenging.
OBJECTIVE: This study aims to evaluate for the first time in literature the effectiveness of the calcium hydroxylapatite (CaHa) filler in the jawline reshaping of a patient with Parry Romberg Syndrome.
CASE REPORT: A 15-year-old woman with progressive atrophy of the right side of the face due to Parry Romberg Syndrome. After disease control, the patient’s main complaint was facial asymmetry, mainly in the jawline region.
DISCUSSION: CaHa is a biocompatible injectable filler that is gradually resorbed and replaced by fibrovascular stroma, mainly formed for new collagen, in a process that occurs without any immunological reaction. This safety profile makes CaHa a good choice for correcting stable scleroderma defects.
CONCLUSION: This report concludes that CaHa filler biocompatibility and suitability for the jawline correction are also applicable in reconstructive procedures for stable scleroderma, safely and minimally invasively, with optimal aesthetic results. The method must be programmed case-by-case, and a regular follow-up is also recommended.

Keywords: Scleroderma localized; Facial hemiatrophy; Dermal fillers

Localized scleroderma (linear morphea) is a rare disease that causes facial dystrophy and asymmetry in young women. We report the case of a 20-year-old female patient who was treated with novel composite fat grafts. After extracting lipoaspirate from deep subcutaneous fat, the microfat and the unfiltered nanofat were processed separately, and amalgamated, obtaining composite fat grafts. These were meticulously transplanted layer by layer to rebuild the subcutaneous tissue of the patient's face. After one year, a good volume of fat retention was observed with successful correction of asymmetry and restoration of facial balance.

Keywords: Ambulatory surgical procedures; Abdominal subcutaneous fat; Facial asymmetry; Subcutaneous injections; Localized scleroderma